Influence of Outlet Boundary Conditions on Cerebrovascular Aneurysm Hemodynamics

Computational fluid dynamic (CFD) studies of blood flow in cerebrovascular aneurysms have potential to improve patient treatment planning by enabling clinicians and engineers to model patient-specific geometries and compute predictors and risks prior to neurovascular intervention. However, the use of patient-specific computational models in clinical settings is unfeasible due to their complexity, computationally intensive and time-consuming nature. An important factor contributing to this challenge is the choice of outlet boundary conditions, which often involves a trade-off between physiological accuracy, patient-specificity, simplicity and speed. In this study, we analyze how resistance and impedance outlet boundary conditions affect blood flow velocities, wall shear stresses and pressure distributions in a patient-specific model of a cerebrovascular aneurysm. We also use geometrical manipulation techniques to obtain a model of the patient’s vasculature prior to aneurysm development, and study how forces and stresses may have been involved in the initiation of aneurysm growth. Our CFD results show that the nature of the prescribed outlet boundary conditions is not as important as the relative distributions of blood flow through each outlet branch. As long as the appropriate parameters are chosen to keep these flow distributions consistent with physiology, resistance boundary conditions, which are simpler, easier to use and more practical than their impedance counterparts, are sufficient to study aneurysm pathophysiology, since they predict very similar wall shear stresses, time-averaged wall shear stresses, time-averaged pressures, and blood flow patterns and velocities. The only situations where the use of impedance boundary conditions should be prioritized is if pressure waveforms are being analyzed, or if local pressure distributions are being evaluated at specific time points, especially at peak systole, where the use of resistance boundary conditions leads to unnaturally large pressure pulses. In addition, we show that in this specific patient, the region of the blood vessel where the neck of the aneurysm developed was subject to abnormally high wall shear stresses, and that regions surrounding blebs on the aneurysmal surface were subject to low, oscillatory wall shear stresses. Computational models using resistance outlet boundary conditions may be suitable to study patient-specific aneurysm progression in a clinical setting, although several other challenges must be addressed before these tools can be applied clinically.

Effet préventif de la milrinone inhalée chez les patients avec hypertension pulmonaire subissant une chirurgie cardiaque sous circulation extracorporelle : une approche pharmacométrique

La circulation extracorporelle (CEC) est une technique utilisée en chirurgie cardiaque effectuée des milliers de fois chaque jour à travers le monde. L’instabilité hémodynamique associée au sevrage de la CEC difficile constitue la principale cause de mortalité en chirurgie cardiaque et l’hypertension pulmonaire (HP) a été identifiée comme un des facteurs de risque les plus importants. Récemment, une hypothèse a été émise suggérant que l'administration prophylactique (avant la CEC) de la milrinone par inhalation puisse avoir un effet préventif et faciliter le sevrage de la CEC chez les patients atteints d’HP. Toutefois, cette indication et voie d'administration pour la milrinone n'ont pas encore été approuvées par les organismes réglementaires. Jusqu'à présent, la recherche clinique sur la milrinone inhalée s’est principalement concentrée sur l’efficacité hémodynamique et l'innocuité chez les patients cardiaques, bien qu’aucun biomarqueur n’ait encore été établi. La dose la plus appropriée pour l’administration par nébulisation n'a pas été déterminée, de même que la caractérisation des profils pharmacocinétiques (PK) et pharmacodynamiques (PD) suite à l'inhalation. L'objectif de notre recherche consistait à caractériser la relation exposition-réponse de la milrinone inhalée administrée chez les patients subissant une chirurgie cardiaque sous CEC. Une méthode analytique par chromatographie liquide à haute performance couplée à un détecteur ultraviolet (HPLC-UV) a été optimisée et validée pour le dosage de la milrinone plasmatique suite à l’inhalation et s’est avérée sensible et précise. La limite de quantification (LLOQ) était de 1.25 ng/ml avec des valeurs de précision intra- et inter-dosage moyennes (CV%) <8%. Des patients souffrant d’HP pour lesquels une chirurgie cardiaque sous CEC était prévue ont d’abord été recrutés pour une étude pilote (n=12) et, par la suite, pour une étude à plus grande échelle (n=28) où la milrinone (5 mg) était administrée par inhalation pré-CEC. Dans l'étude pilote, nous avons comparé l'exposition systémique de la milrinone peu après son administration avec un nébuliseur pneumatique ou un nébuliseur à tamis vibrant. L’efficacité des nébuliseurs en termes de dose émise et dose inhalée a également été déterminée in vitro. Dans l'étude à plus grande échelle conduite en utilisant exclusivement le nébuliseur à tamis vibrant, la dose inhalée in vivo a été estimée et le profil pharmacocinétique de la milrinone inhalée a été pleinement caractérisé aux niveaux plasmatique et urinaire. Le ratio de la pression artérielle moyenne sur la pression artérielle pulmonaire moyenne (PAm/PAPm) a été choisi comme biomarqueur PD. La relation exposition-réponse de la milrinone a été caractérisée pendant la période d'inhalation en étudiant la relation entre l'aire sous la courbe de l’effet (ASCE) et l’aire sous la courbe des concentrations plasmatiques (ASC) de chacun des patients. Enfin, le ratio PAm/PAPm a été exploré comme un prédicteur potentiel de sortie de CEC difficile dans un modèle de régression logistique. Les expériences in vitro ont démontré que les doses émises étaient similaires pour les nébuliseurs pneumatique (64%) et à tamis vibrant (68%). Cependant, la dose inhalée était 2-3 fois supérieure (46% vs 17%) avec le nébuliseur à tamis vibrant, et ce, en accord avec les concentrations plasmatiques. Chez les patients, en raison des variations au niveau des facteurs liés au circuit et au ventilateur causant une plus grande dose expirée, la dose inhalée a été estimée inférieure (30%) et cela a été confirmé après récupération de la dose de milrinone dans l'urine 24 h (26%). Les concentrations plasmatiques maximales (Cmax: 41-189 ng/ml) et l'ampleur de la réponse maximale ΔRmax-R0 (0-65%) ont été observées à la fin de l'inhalation (10-30 min). Les données obtenues suite aux analyses PK sont en accord avec les données publiées pour la milrinone intraveineuse. Après la période d'inhalation, les ASCE individuelles étaient directement reliées aux ASC (P=0.045). Enfin, notre biomarqueur PD ainsi que la durée de CEC ont été identifiés comme des prédicteurs significatifs de la sortie de CEC difficile. La comparaison des ASC et ASCE correspondantes a fourni des données préliminaires supportant une preuve de concept pour l'utilisation du ratio PAm/PAPm comme biomarqueur PD prometteur et justifie de futures études PK/PD. Nous avons pu démontrer que la variation du ratio PAm/PAPm en réponse à la milrinone inhalée contribue à la prévention de la sortie de CEC difficile.

Nouvelles approches thérapeutiques pour la dysfonction endothéliale et l'hypertension pulmonaire secondaire à la circulation extracorporelle chez le porc

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Système endothéline et circulation pulmonaire

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Étude des effets de la tétrahydrobioptérine sur la dysfonction endothéliale des artères coronaires induite par circulation extracorporelle dans un modèle porcin

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

L'utilisation prophylactique du sildénafil dans la dysfonction endothéliale des artères pulmonaires secondaire à la circulation extracorporelle dans un modèle porcin

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

The Atlantic Meridional Overturning Circulation during the last glacial

We reconstruct the geometry and strength of the Atlantic Meridional Overturning Circulation during Heinrich Stadial 2 and three Greenland interstadials of the 20-50 ka period based on the comparison of new and published sedimentary 231Pa/230Th data with simulated sedimentary 231Pa/230Th. We show that the deep Atlantic circulation during these interstadials was very different from that of the Holocene. Northern-sourced waters likely circulated above 2500 m depth, with a flow rate lower than that of the present day North Atlantic Deep Water (NADW). Southern-sourced deep waters most probably flowed northwards below 4000 m depth into the North Atlantic basin, and then southwards as a return flow between 2500 and 4000 m depth. The flow rate of this southern-sourced deep water was likely larger than that of the modern Antarctic Bottom Water (AABW). Our results further show that during Heinrich Stadial 2, the deep Atlantic was probably directly affected by a southern-sourced water mass below 2500 m depth, while a slow southward flowing water mass originating from the North Atlantic likely influenced depths between 1500 and 2500 m down to the equator.

Tidal and wind influences on circulation in the southern mouth of the Ría de Vigo (NW Iberian Peninsula)

Tidal and wind influences on the velocity field in the Ría de Vigo were assessed using atmospheric data from two meteorological stations located at Bouzas port and on an oceanic buoy off Silleiro Cape along with oceanic data from an ADCP moored in the Ría for a 72-day period. A two-layer circulation pattern was observed. Near-surface and near-bottom currents are primarily influenced by wind (especially remote winds), separated by an intermediate layer dominated by tidal variability. At subtidal frequencies, residual currents are well correlated with wind variability. Remote wind forcing exhibited a markedly high correlation with surface layer currents, indicating the major role played by wind in the long-term upwelling-modulated circulation of the Ría.

Tidal and wind influences on circulation in the southern mouth of the Ría de Vigo (NW Iberian Peninsula)

Tidal and wind influences on the velocity field in the Ría de Vigo were assessed using atmospheric data from two meteorological stations located at Bouzas port and on an oceanic buoy off Silleiro Cape along with oceanic data from an ADCP moored in the Ría for a 72-day period. A two-layer circulation pattern was observed. Near-surface and near-bottom currents are primarily influenced by wind (especially remote winds), separated by an intermediate layer dominated by tidal variability. At subtidal frequencies, residual currents are well correlated with wind variability. Remote wind forcing exhibited a markedly high correlation with surface layer currents, indicating the major role played by wind in the long-term upwelling-modulated circulation of the Ría.

The Roles of Land and Orography on Precipitation and Ocean Circulation in Global Climate Models

Thesis (Ph.D.)--University of Washington, 2016-08

A three dimensional model of Caspian Sea circulation

Observations of Caspian Sea during August - September 1995 are used to develop a three dimensional numerical for calculating temperature and current. This period was chosen because of extensive set of observational data including surface temperature observations. Data from the meteorological buoy network on Caspian Sea are combined with routine observation at first order synoptic station around the lake to obtain hourly values of wind stress and pressure fields. Initial temperature distribution as a function of depth and horizontal coordinates are derived from ship cruises. The model has variable grid resolution and horizontal smoothing which filters out small scale vertical motion. The hydrodynamic model of Caspian Sea has 6 vertical levels and a uniform horizontal grid size of 50 km The model is driven with surface fluxes of heat and momentum derived from observed meteorological. The model was able to reproduce all of the basic feature of the thermal structure in Caspian sea and: larger scale circulation patterns tend to be cyclone, with cyclone circulation with each sub basin. Result has agreement with observations.

Three dimensional circulation of water with variable wind in the Caspian Sea

This research is based on a numerical model for forecasting the three-dimensional behavior of (sea) water motion due to the effect of a variable wind velocity. The results obtained are then analyzed and compared with observation. This model is based on the equations that overcome the current and distribution of temperature by applying the method of finite difference with assuming Δx, Δy as constant and Δz, variable. The model is based on the momentum equation, continuity equation and thermodynamic energy equation and tension at the surface and middle layers and bottom stress. The horizontal and vertical eddy viscosity and thermal diffusivity coefficients we used in accordance with that of the Bennet on Outario Lake (1977). Considering the Caspian Sea dimension in numerical model the Coriolis parameter used with β effects and the approximation Boussines have been used. For the program controlling some simple experiment with boundary condition similar to that of the Caspian Sea have been done. For modeling the Caspian Sea the grid of the field was done as follows: At horizontal surface grid size is 10×10km extension and at vertical in 10 layers with varying thickness from surface to bed respectively as: 5, 10, 20, 3, 50, 100, 150, 200, 25, 500 and higher. The data of wind as velocity، direction and temperature of water related to 15th September 1995 at 6،12 and 18 o’clock were obtained from synoptic station at the Caspian Sea shore and the research marine of Haji Alief. The information concerning shore wind was measured and by the method of SPM (shore protection manual) was transferred to far shore winds through interpolation and by use of inverse square distance of position distribution of the wind velocity at the Caspian surface field was obtained. The model has been evaluated according to the reports and observations. Through studying the position of the current in different layers، the velocity in the cross section in the northern، southern and the middle layers، will be discussed. The results reveal the presence of the circulation cells in the three above mentioned areas. The circulation with depth is reduced too. The results obtained through the numerical solution of the temperature equation have been compared with the observation. The temperature change in different layers in cross section illustrates the relative accordance of the model mentioned.